2021-05-06T13:24:17-05:00 2020-06-30 593204548 JAMES MOORE & CO PL 2477 TIM GAMBLE PLACE SUITE 200 TALLAHASSEE FL 323084386 990 2019-07-01 571234883 FLORIDA MEDICAL PRACTICE PLAN INC FLOR 8506452827 1115 W CALL ST TALLAHASSEE FL 323043556 JOHN FOGARTY MD PRESIDENT 8502247144 2021-05-03 1 KEVIN WARREN P00642409 8503866184 2021-05-03 2019 2022-09-23 18:48:47Z JOHN FOGARTY MD 1115 W CALL ST TALLAHASSEE FL 323043556 7625682 0 X WWW.MED.FSU.EDU/FMPP X 2006 FL THE PURPOSES OF FLORIDA MEDICAL PRACTICE PLAN ARE TO: 1) FURTHER THE EDUCATION, SERVICE, AND RESEARCH MISSIONS OF THE FLORIDA STATE UNIVERSITY COLLEGE OF MEDICINE, A COMPONENT OF THE FLORIDA STATE UNIVERSITY BOARD OF TRUSTEES; AND 2) ENABLE FACULTY TO MAINTAIN CLINICAL COMPETENCE, FULFILL CERTIFICATION REQUIREMENTS, SHARE EXPERTISE WITH OTHER HEALTH CARE PROVIDERS, AND SERVE AS CLINICAL TEACHERS FOR STUDENTS AND RESIDENT PHYSICIANS. 12 0 0 0 0 0 0 0 5982062 7486569 224889 139113 21114 0 6228065 7625682 200090 239473 0 0 4549046 6124366 0 0 0 1815382 1609488 6564518 7973327 -336453 -347645 6455956 6439041 2504313 3306300 3951643 3132741 X THE PURPOSES OF FLORIDA MEDICAL PRACTICE PLAN ARE TO: 1) FURTHER THE EDUCATION, SERVICE, AND RESEARCH MISSIONS OF THE FLORIDA STATE UNIVERSITY COLLEGE OF MEDICINE, A COMPONENT OF THE FLORIDA STATE UNIVERSITY BOARD OF TRUSTEES; AND 2) ENABLE FACULTY TO MAINTAIN CLINICAL COMPETENCE, FULFILL CERTIFICATION REQUIREMENTS, SHARE EXPERTISE WITH OTHER HEALTH CARE PROVIDERS, AND SERVE AS CLINICAL TEACHERS FOR STUDENTS AND RESIDENT PHYSICIANS. 0 0 7852959 239473 7486569 PERFORMED PROFESSIONAL SERVICES IN SUPPORT OF: 1) AN AFFILIATION AGREEMENT WITH A HOSPITAL FOR GRADUATE MEDICAL EDUCATION PROGRAMS, AND 2) AGREEMENTS WITH HEALTH DEPARTMENTS, CLINICS, AND OTHER FOR PATIENT CARE. 7852959 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 1 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 22 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 12 0 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X DAWN SNYDER 8506445024 1115 WEST CALL STREET TALLAHASSEE FL 32306 DANIEL VAN DURME MD VICE PRESIDENT 1.00 40.00 X X 0 305889 44493 ALMA LITTLES MD SECRETARY 1.00 40.00 X X 0 315544 41866 JOHN FOGARTY MD PRESIDENT 2.00 40.00 X X 0 423219 41801 RICHARD NOWAKOWSKI PHD TREASURER 1.00 40.00 X X 0 261251 32818 LESLIE BEITSCH MD JD DIRECTOR 1.00 40.00 X 0 285306 58861 KYLE CLARK MBA DIRECTOR 0.50 40.00 X 0 384360 43768 SALLIE MCRORIE PHD DIRECTOR 0.50 40.00 X 0 406692 43656 JONATHAN APPELBAUM MD DIRECTOR 1.00 40.00 X 0 309919 41742 PAUL KATZ MD DIRECTOR 1.00 40.00 X 0 305968 41740 JOEDRECKA BROWN SPEIGHTS MD DIRECTOR 1.00 40.00 X 0 299586 34113 JAMES ZEDAKER MPAS PA-C DFAAPA DIRECTOR 1.00 40.00 X 0 178318 33509 JOAN MEEK MD MS DIRECTOR 1.00 40.00 X 0 243878 29959 0 3719930 488326 0 0 1 0 MARY TERRY MEEK 3244 ARBOR HILL WAY TALLAHASSEE FL 32309 CFMSD 192640 COMMERICAL DESIGN SOLUTIONS 508-C CAPITAL CIRCLE SE TALLAHASSEE FL 32301 FURNITURE AND FSU PRIMARY HEALTH CLINIC 160499 2 CLINICAL REVENUE 624100 7212867 7212867 MEDICAID REVENUE 624100 273702 273702 7486569 139113 139113 7625682 7486569 0 139113 239473 239473 4887235 4887235 365881 365881 615345 615345 255905 255905 19000 19000 206586 206586 13623 13623 87745 87745 67937 67937 53963 53963 14540 14540 529022 529022 PROGRAM DEVELOPMENT 409867 409867 MEDICAL SUPPLIES 182112 182112 BANKING FEES 25093 25093 7973327 7852959 120368 0 1162 14578 856741 1454837 948936 464715 80516 47510 129100 18871 108559 110229 1185320 1746905 3274722 2600267 6455956 6439041 220174 171725 87500 125864 2196639 3008711 2504313 3306300 X 0 0 0 0 3951643 3132741 3951643 3132741 6455956 6439041 -347645 -471258 0 X X 0 1 X 1 0 X X X 1 FLORIDA STATE UNIVERSITY 591961248 2 1 6124365 0 1 6124365 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 129100 18871 110229 110229 FSU FOUNDATION 853955 F FLORIDA SPECIAL PURPOSE INVESTMENT ACCOUNT (VIA UNIVERSITY) 1746312 F 2600267 FLORIDA STATE UNIVERSITY AUXILIARY 1439886 DEPARTMENTAL DISTRIBUTION 1568825 3008711 X 7625682 0 7625682 0 7625682 7973326 0 7973326 0 7973326 PART X, LINE 2: IT IS THE POLICY OF MANAGEMENT TO EVALUATE ITS TAX POSITIONS ON AN ONGOING BASIS AND TO DISCLOSE ANY SUCH POSITIONS IT BELIEVES WOULD HAVE A MATERIAL IMPACT ON THE FINANCIAL STATEMENTS AND RELATED NOTES. MANAGEMENT ALSO BELIEVES THAT NO SUCH REQUIRED DISCLOSURES CURRENTLY EXIST. CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, 0 0 PROGRAM SERVICE MEDICAL MISSION FACULTY TRIPS. 1250 EUROPE (INCLUDING ICELAND & GREENLAND) - ALBANIA, ANDORRA, AUSTRIA, BELGIUM 0 0 PROGRAM SERVICE FACULTY TRIP TO ATTEND SCHOOL OF HEALTH PROFESSIONS EDUCATION PHD WRITING COURSE 1664 EUROPE (INCLUDING ICELAND & GREENLAND) - SWEDEN 0 0 PROGRAM SERVICE FACULTY TRIP TO PERFORM WORK FOR THE ENVIRONMENTAL DETERMINANTS OF DIABETES IN THE YOUNG 310 EUROPE (INCLUDING ICELAND & GREENLAND) - FRANCE 0 0 PROGRAM SERVICE FACULTY TRIP TO ATTEND THE PHARMAXY SYMPOSIUM 549 0 0 0 0 0 0 3773 0 3773 0 0 0 0 0 0 PART III ACCOUNTING METHOD: 0 FLORIDA STATE UNIVERSITY COLLEGE OF MEDICINE 1115 WEST CALL STREET TALLAHASSEE FL 32306 591961248 501(C)(3) 239473 DEPARTMENTAL DISTRBUTION SUPPORT 0 0 0 0 0 0 0 0 0 DANIEL VAN DURME MD VICE PRESIDENT 0 304389 0 1500 0 0 0 26706 0 17787 0 350382 0 0 ALMA LITTLES MD SECRETARY 0 314044 0 1500 0 0 0 24079 0 17787 0 357410 0 0 JOHN FOGARTY MD PRESIDENT 0 421719 0 1500 0 0 0 24014 0 17787 0 465020 0 0 RICHARD NOWAKOWSKI PHD TREASURER 0 259751 0 1500 0 0 0 23003 0 9815 0 294069 0 0 LESLIE BEITSCH MD JD DIRECTOR 0 283806 0 1500 0 0 0 41074 0 17787 0 344167 0 0 KYLE CLARK MBA DIRECTOR 0 374460 0 1200 0 8700 0 24029 0 19739 0 428128 0 0 SALLIE MCRORIE PHD DIRECTOR 0 399192 0 1500 0 6000 0 34710 0 8946 0 450348 0 0 JONATHAN APPELBAUM MD DIRECTOR 0 308419 0 1500 0 0 0 23955 0 17787 0 351661 0 0 PAUL KATZ MD DIRECTOR 0 304468 0 1500 0 0 0 23953 0 17787 0 347708 0 0 JOEDRECKA BROWN SPEIGHTS MD DIRECTOR 0 298086 0 1500 0 0 0 24959 0 9154 0 333699 0 0 JAMES ZEDAKER MPAS PA-C DFAAPA DIRECTOR 0 176818 0 1500 0 0 0 15722 0 17787 0 211827 0 0 JOAN MEEK MD MS DIRECTOR 0 241918 0 1500 0 460 0 21674 0 8285 0 273837 0 0 PART I, LINE 3 COMPENSATION FOR THE ORGANIZATION'S OFFICERS/FACULTY ARE DETERMINED BY THE FLORIDA STATE UNIVERSITY COLLEGE OF MEDICINE AND APPROVED BY FSU'S HUMAN RESOURCE DEPARTMENT (A RELATED ORGANIZATION). THE COMPENSATION IS ESTABLISHED BASED ON BENCHMARKS WITHIN THE INDUSTRY. IN ADDITION, FSU UTILIZES A COMPENSATION COMMITTEE, WRITTEN EMPLOYMENT CONTRACTS AND APPROVAL BY THE BOARD/COMPENSATION COMMITTEE TO ESTABLISH COMPENSATION. FORM 990, PART VI, SECTION A, LINE 2 SALLIE MCRORIE, PH.D. AND KYLE CLARK, MBA SERVE TOGETHER ON THE FOLLOWING ORGANIZATION BOARDS: FAMU-FSU COLLEGE OF ENGINEERING JOINT MANAGEMENT COUNCIL, FSU INTERNATIONAL PROGRAMS ASSOCIATION, INC., AND THE FSU RESEARCH FOUNDATION, INC. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FINAL FORM 990 WAS PROVIDED TO THE BOARD OF DIRECTORS THROUGH ELECTRONIC MAIL PRIOR TO SUBMITTAL TO THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C ANY DIRECTOR, PRINCIPAL, OFFICER, OR MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS, WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST, IS COVERED UNDER THE POLICY. ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST MUST BE DISCLOSED TO THE DIRECTORS, AND THE DIRECTORS WILL DECIDE IF A CONFLICT OF INTEREST EXISTS. IF A MEMBER FAILS TO DISCLOSE A CONFLICT OF INTEREST IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION FOR THE ORGANIZATION'S TOP OFFICIAL, OFFICERS, AND KEY EMPLOYEES IS DETERMINED BY FAIR MARKET VALUE, SALARY SURVEYS AND A SALARY RANGE PROVIDED BY FLORIDA STATE UNIVERSITY, THE SUPPORTED ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990 PART XII, LINE 2C THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FLORIDA STATE UNIVERSITY A2201 UNIVERSITY CENTER TALLAHASSEE FL 32306 591961248 UNIVERSITY FL 115(1) N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 FLORIDA STATE UNIVERSITY O 6124365 CASH